Provider Demographics
NPI:1063613446
Name:WOOD, MARIAN EVELYN (MSW)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:EVELYN
Last Name:WOOD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 ONEAL LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3314
Mailing Address - Country:US
Mailing Address - Phone:225-753-0478
Mailing Address - Fax:
Practice Address - Street 1:2426 ONEAL LN
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3314
Practice Address - Country:US
Practice Address - Phone:225-753-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health